Provider Demographics
NPI:1720688393
Name:HENDRIXSON, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:HENDRIXSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6028 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-6553
Mailing Address - Country:US
Mailing Address - Phone:513-703-0459
Mailing Address - Fax:
Practice Address - Street 1:8451 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3926
Practice Address - Country:US
Practice Address - Phone:513-245-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist